Vision Problems After Stroke: A Care Staff Guide

A resident recovering from a stroke keeps bumping into the door frame on their left. At mealtimes they eat only the food on the right side of their plate, and they seem not to notice the person standing on their left. Staff may assume they are being careless or not paying attention. In fact, they may be living with vision problems caused by the stroke, which are common and often missed.

This guide explains the main types of vision problem after a stroke, the signs care staff may notice, who assesses them and how to support the person day to day. It draws on the Stroke Association's information on understanding stroke-related vision problems. The page shows no review date, so check the latest Stroke Association guidance alongside this article.

Types of vision problem after stroke

The Stroke Association describes several kinds of problem:

• Visual field loss: missing part of the field of vision, often on the same side in both eyes. Hemianopia means half the field is lost, quadrantanopia means a quarter, and a scotoma is a small patch, often central.
• Eye movement problems: poor coordination of the eyes, double vision or nystagmus (wobbling eyes).
• Visual processing problems: difficulty recognising objects, faces, colours or text. This includes visual inattention, also called neglect, where the person is unaware of one side, often due to a stroke on the right side of the brain.
• Other sight problems: dry eyes or incomplete eye closure, sensitivity to light, visual hallucinations (Charles Bonnet syndrome) and an "eye stroke" caused by blocked blood vessels in the retina, which affects one eye rather than both.

Our guide to Charles Bonnet syndrome explains why seeing images that are not there does not always mean confusion or mental illness. For more on supporting people with sight loss in general, see our guide to visual impairment support.

Signs care staff may notice

The person may not realise that their vision has changed, and the signs below can easily be put down to something else. The Stroke Association describes these experiences, which staff may see as:

• Bumping into objects or people, especially on one side.
• Ignoring people or items on one side.
• Trouble reading, such as difficulty finding the start of a line or the next line.
• Seeing only part of a television, phone or their own face in a mirror.
• Difficulty in crowds or unfamiliar places.
• Misjudging positions, such as pouring a drink beside the cup.
• Double or blurred vision, or eyes that wobble.
• Eyes that stay open during sleep, or dry, irritated eyes.
• Discomfort with bright light or glare.
• Seeing images that are not there.

These signs can easily be mistaken for confusion, poor concentration or lack of cooperation. If you notice them in someone who has had a stroke, describe what you see factually and pass it on so the person can be assessed. Our guide to stroke recognition and the FAST test covers the emergency signs of a new stroke; sudden vision loss is a reason to act urgently and follow your emergency procedure.

Who assesses vision problems?

According to the Stroke Association, different professionals look at different problems:

• An eye or rehabilitation specialist can assess overall eye problems.
• An occupational therapist can help with scanning and coping strategies.
• An orthoptist assesses eye movement problems.
• A GP, eye health specialist or specialist stroke nurse should be told about hallucinations or other new symptoms.

Treatment and support

The Stroke Association describes a range of approaches, which depend on the type of problem:

• Visual field loss: visual scanning training, free online therapies (it names EyeSearch and ReadRight), prism lenses in glasses (which may cause double vision, confusion or headaches in some people), and practical aids such as line guides, good lighting and edge markers for reading.
• Eye movement problems: eye exercises, prisms for double vision, and an eye patch, which can make it easier to see but can also cause some difficulty because only one eye is used.
• Visual processing problems: scanning towards the affected side and using touch or hearing to compensate.
• Other problems: lubricating drops or ointment for dry eyes, taping the eyelid closed at night if advised, tinted overlays or sunglasses for glare, and support groups for hallucinations, for which there is no medicine.

Treatment and equipment decisions belong to the specialists. Care staff's role is to make sure that exercises, drops and aids are used as agreed.

Practical tips for care staff

The Stroke Association's advice is written mainly for the person with the vision problem; it suggests that family and friends approach from the affected side. The steps below turn its advice into practical support for staff:

• Approach the person from their affected side.
• Encourage scanning during everyday tasks.
• Use line guides, edge markers and good lighting for reading.
• Check for missed obstacles on the affected side.
• Report new hallucinations to a GP or stroke nurse.
• Watch for dry or irritated eyes and seek early treatment.

The points below are general good practice rather than Stroke Association advice. Keep walkways clear and furniture in the same place. Serve food and place drinks where the person can see them, and tell them what is on the plate. Announce yourself when you enter the room. Include vision in falls risk assessments and the care plan, and tell new or agency staff about the person's vision needs.

Training and CPD

Understanding how a stroke affects vision helps staff respond with patience instead of frustration. Record your learning in your CPD log, discuss real examples in supervision, and browse the options on our CPD pages.

Key points to remember

• Vision problems after stroke include visual field loss, eye movement problems, visual processing problems and other sight problems.
• The person may not know their vision has changed; staff often notice first.
• Bumping into things on one side, missing food or struggling to read are common signs.
• Different specialists assess different problems; report concerns so referrals can be made.
• Approach from the affected side, encourage scanning and keep the environment predictable.

Frequently asked questions

Is hemianopia the same as being blind on one side?

No. The Stroke Association describes hemianopia as losing half of the field of vision, often on the same side in both eyes. The person can still see on the other side.

Can vision problems after stroke improve?

The Stroke Association describes treatments and training, such as scanning training and eye exercises, that can help people cope with or reduce some problems. Ask the specialist team what to expect for the person.

Does seeing things that are not there mean a mental health problem?

Not necessarily. The Stroke Association lists visual hallucinations (Charles Bonnet syndrome) as a possible sight problem after stroke and advises reporting them to a GP or stroke nurse.

This guide is for general information and is not a substitute for clinical advice or your organisation's policies.